EP2007904A2 - Propagation of primary cells - Google Patents
Propagation of primary cellsInfo
- Publication number
- EP2007904A2 EP2007904A2 EP07753058A EP07753058A EP2007904A2 EP 2007904 A2 EP2007904 A2 EP 2007904A2 EP 07753058 A EP07753058 A EP 07753058A EP 07753058 A EP07753058 A EP 07753058A EP 2007904 A2 EP2007904 A2 EP 2007904A2
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- European Patent Office
- Prior art keywords
- cells
- protein
- nucleic acid
- cell
- analysis
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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- C—CHEMISTRY; METALLURGY
- C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
- C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
- C12Q1/00—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions
- C12Q1/68—Measuring or testing processes involving enzymes, nucleic acids or microorganisms; Compositions therefor; Processes of preparing such compositions involving nucleic acids
- C12Q1/6876—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes
- C12Q1/6883—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material
- C12Q1/6886—Nucleic acid products used in the analysis of nucleic acids, e.g. primers or probes for diseases caused by alterations of genetic material for cancer
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
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- C—CHEMISTRY; METALLURGY
- C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
- C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
- C12Q2600/00—Oligonucleotides characterized by their use
- C12Q2600/118—Prognosis of disease development
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- C—CHEMISTRY; METALLURGY
- C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
- C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
- C12Q2600/00—Oligonucleotides characterized by their use
- C12Q2600/154—Methylation markers
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- C—CHEMISTRY; METALLURGY
- C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
- C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
- C12Q2600/00—Oligonucleotides characterized by their use
- C12Q2600/16—Primer sets for multiplex assays
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- C—CHEMISTRY; METALLURGY
- C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
- C12Q—MEASURING OR TESTING PROCESSES INVOLVING ENZYMES, NUCLEIC ACIDS OR MICROORGANISMS; COMPOSITIONS OR TEST PAPERS THEREFOR; PROCESSES OF PREPARING SUCH COMPOSITIONS; CONDITION-RESPONSIVE CONTROL IN MICROBIOLOGICAL OR ENZYMOLOGICAL PROCESSES
- C12Q2600/00—Oligonucleotides characterized by their use
- C12Q2600/178—Oligonucleotides characterized by their use miRNA, siRNA or ncRNA
Definitions
- Metastases are the leading cause of death in patients diagnosed with a primary tumor. Cancer metastasis occurs when cells shed from the primary tumor and disseminate to distant parts of the body though the peripheral blood stream or lymphatic drainage. The presence of CTCs in peripheral blood has been shown to be associated with decreased progression-free survival and decreased overall survival in patients treated for metastatic breast cancer. Although mechanical forces or an individual's immune response kills a number of these tumor cells entering the blood stream, it is known that a percentage of tumor cells survive and can be analyzed. The presence, enumeration and characterization of these rare epithelial cells in whole blood could provide valuable diagnostic and clinical information. Approximately 70-80% of all solid tumors originate from epithelial cells, which are not normally found in circulation.
- the comprehensive analyses of mRNA of circulating epithelial cells in the peripheral blood may provide valuable information on tumor load prognosis and treatment efficacy.
- the Her-2 receptor is over expressed in only 30% of breast cancer patients, which suggests that Herceptin would be an ineffective therapy for all patients.
- molecular profiling of CTCs should lead to improved characterization of CTCs and ultimately to development of more effective, personalized novel therapeutic strategies.
- CTCs circulating tumor cells
- Presence of these CTCs in blood as detected by CellSearchTM technology has been shown to be associated with decreased survival rate thus serving as predictable "markers" for cancer progression (metastasis).
- CTCs could potentially be used for pharmacogenomic studies (example, chemosensitivity).
- molecular profiling studies can be carried out on the CTCs which should further lead us to better understanding of underlying mechanisms of metastatic potential/progression, prognosis and even therapeutic utility.
- the challenges are several fold: recovery of quality nucleic acids from CTCs; their availability in very limited quantity; sensitivity limitations of the existing assays; application/validation of existing marker sets for the CTCs. Furthermore, the molecular profiling always may not lead to accurate results due to the contamination of the captured CTCs with leukocytes whose expression profile may interfere with the results. Adapting the CTCs to grow in vitro could result in propagating the cells to sufficient levels and alleviate the afore-mentioned challenges. The cells thus propagated could be used for various applications including assessing the clonality of different cell populations, discovery of signatures, development of assays using such signatures, fluorescent in situ hybridization (FISH) and immuno-histochemistry (IHC).
- FISH fluorescent in situ hybridization
- IHC immuno-histochemistry
- CTCs circulating tumor cells
- Gene expression in cancer can be disrupted either through genetic alteration or epigenetic alteration, which alter the heritable state of gene expression.
- the main epigenetic modification of the human genome is methylation of cytosine residues within the context of the CpG dinucleotide.
- DNA methylation is interesting from a diagnostic viewpoint because it may be easily detected in cells released from neoplastic and pre-neoplastic lesions into serum, urine or sputum. And from a therapeutic viewpoint because epigenetically silenced genes may be reactivated by inhibitors of DNA methylation and/or histone deacetylase.
- the present invention provides methods, apparatus and kits for sample processing of circulating tumor cells (CTC) within peripheral blood and assessing their gene expression profiles while providing support for the CellSearchTM platform for disease recurrence testing.
- the CellSearchTM Profile Kit is intended for the isolation of CTCs of epithelial origin in whole blood in conjunction with the CellSearch® AutoPrep System.
- the CellSearchTM Profile Kit contains a ferrofluid-based capture reagent, which consists of nano-particles with a magnetic core surrounded by a polymeric layer coated with antibodies targeting the Epithelial Cell Adhesion Molecule (EpCAM) antigen for capturing CTCs.
- EpCAM Epithelial Cell Adhesion Molecule
- the CellTracksTM AutoPrep System automates and standardizes processing by precisely dispensing reagents and timing magnetic incubation steps, offering scientists advanced tools to reproducibly and efficiently isolate CTCs for important research in a variety of carcinomas.
- the vast majority of leukocytes and other blood components are depleted from the enriched sample, thereby minimizing background. Further analysis is performed using established molecular biology techniques including RT-PCR and multiplex RT-PCR.
- the Molecular characterization assay is a molecular diagnostic assay that is intended for use following CTC enrichment. This assay incorporates both epithelial and tissue of origin markers to confirm circulating cells in a patient previously diagnosed and treated for breast cancer are in fact breast in origin.
- Figure 1 is a graph depicting RNA stability over time.
- Figure 2 is a graph depicting prostate-specific mRNA obtained from circulating tumor cells.
- Figure 3 is a graph depicting prostate-specific mRNA obtained from circulating tumor cells.
- Figure 4 depicts the results from A) lOOng PBL DNA Spiking; or B) in 500ng PBL DNA Spiking.
- a Biomarker is any indicia of an indicated Marker nucleic acid/protein.
- Nucleic acids can be any known in the art including, without limitation, nuclear, mitochondrial (homeoplasmy, heteroplasmy), viral, bacterial, fungal, mycoplasmal, etc.
- the indicia can be direct or indirect and measure over- or under-expression of the gene given the physiologic parameters and in comparison to an internal control, placebo, normal tissue or another carcinoma.
- Biomarkers include, without limitation, nucleic acids and proteins (both over and under-expression and direct and indirect).
- nucleic acids as Biomarkers can include any method known in the art including, without limitation, measuring DNA amplification, deletion, insertion, duplication, RNA, micro RNA (miRNA), loss of heterozygosity (LOH), single nucleotide polymorphisms (SNPs, Brookes (1999)), copy number polymorphisms (CNPs) either directly or upon genome amplification, microsatellite DNA, epigenetic changes such as DNA hypo- or hyper-methylation and FISH.
- miRNA micro RNA
- LH loss of heterozygosity
- SNPs single nucleotide polymorphisms
- CNPs copy number polymorphisms
- Biomarkers includes any method known in the art including, without limitation, measuring amount, activity, modifications such as glycosylation, phosphorylation, ADP-ribosylation, ubiquitination, etc., or imunohistochemistry (IHC) and turnover.
- Other Biomarkers include imaging, molecular profiling, cell count and apoptosis Markers.
- Ultrasound as referred to in 'tissue of origin' means either the tissue type (lung, colon, etc.) or the histological type (adenocarcinoma, squamous cell carcinoma, etc.) depending on the particular medical circumstances and will be understood by anyone of skill in the art.
- a Marker gene corresponds to the sequence designated by a SEQ ID NO when it contains that sequence.
- a gene segment or fragment corresponds to the sequence of such gene when it contains a portion of the referenced sequence or its complement sufficient to distinguish it as being the sequence of the gene.
- a gene expression product corresponds to such sequence when its RNA, mRNA, or cDNA hybridizes to the composition having such sequence (e.g. a probe) or, in the case of a peptide or protein, it is encoded by such mRNA.
- a segment or fragment of a gene expression product corresponds to the sequence of such gene or gene expression product when it contains a portion of the referenced gene expression product or its complement sufficient to distinguish it as being the sequence of the gene or gene expression product.
- Marker genes include one or more Marker genes.
- Marker or “Marker gene” is used throughout this specification to refer to genes and gene expression products that correspond with any gene the over- or under-expression of which is associated with an indication or tissue type.
- Preferred methods for establishing gene expression profiles include determining the amount of RNA that is produced by a gene that can code for a protein or peptide. This is accomplished by reverse transcriptase PCR (RT-PCR), competitive RT-PCR, real time RT-PCR, differential display RT-PCR, Northern Blot analysis and other related tests. While it is possible to conduct these techniques using individual PCR reactions, it is best to amplify complementary DNA (cDNA) or complementary RNA (cRNA) produced from mRNA and analyze it via microarray.
- RT-PCR reverse transcriptase PCR
- competitive RT-PCR competitive RT-PCR
- real time RT-PCR real time RT-PCR
- differential display RT-PCR differential display RT-PCR
- Northern Blot analysis and other related tests. While it is possible to conduct these techniques using individual PCR reactions, it is best to amplify complementary DNA (cDNA) or complementary RNA (cRNA) produced from mRNA and analyze it via microarray.
- Microarray technology allows for the measurement of the steady-state mRNA level of thousands of genes simultaneously thereby presenting a powerful tool for identifying effects such as the onset, arrest, or modulation of uncontrolled cell proliferation.
- Two microarray technologies are currently in wide use. The first are cDNA arrays and the second are oligonucleotide arrays. Although differences exist in the construction of these chips, essentially all downstream data analysis and output are the same.
- the product of these analyses are typically measurements of the intensity of the signal received from a labeled probe used to detect a cDNA sequence from the sample that hybridizes to a nucleic acid sequence at a known location on the microarray.
- the intensity of the signal is proportional to the quantity of cDNA, and thus mRNA, expressed in the sample cells.
- mRNA mRNA
- Analysis of the expression levels is conducted by comparing such signal intensities. This is best done by generating a ratio matrix of the expression intensities of genes in a test sample versus those in a control sample. For instance, the gene expression intensities from a diseased tissue can be compared with the expression intensities generated from benign or normal tissue of the same type. A ratio of these expression intensities indicates the fold-change in gene expression between the test and control samples.
- the selection can be based on statistical tests that produce ranked lists related to the evidence of significance for each gene's differential expression between factors related to the tumor's original site of origin. Examples of such tests include ANOVA and Kruskal-Wallis.
- the rankings can be used as weightings in a model designed to interpret the summation of such weights, up to a cutoff, as the preponderance of evidence in favor of one class over another. Previous evidence as described in the literature may also be used to adjust the weightings.
- a preferred embodiment is to normalize each measurement by identifying a stable control set and scaling this set to zero variance across all samples.
- This control set is defined as any single endogenous transcript or set of endogenous transcripts affected by systematic error in the assay, and not known to change independently of this error. All Markers are adjusted by the sample specific factor that generates zero variance for any descriptive statistic of the control set, such as mean or median, or for a direct measurement. Alternatively, if the premise of variation of controls related only to systematic error is not true, yet the resulting classification error is less when normalization is performed, the control set will still be used as stated. Non-endogenous spike controls could also be helpful, but are not preferred.
- Gene expression profiles can be displayed in a number of ways. The most common is to arrange raw fluorescence intensities or ratio matrix into a graphical dendogram where columns indicate test samples and rows indicate genes. The data are arranged so genes that have similar expression profiles are proximal to each other. The expression ratio for each gene is visualized as a color. For example, a ratio less than one (down-regulation) appears in the blue portion of the spectrum while a ratio greater than one (up-regulation) appears in the red portion of the spectrum.
- Commercially available computer software programs are available to display such data including "Genespring” (Silicon Genetics, Inc.) and “Discovery” and “Infer” (Partek, Inc.)
- protein levels can be measured by binding to an antibody or antibody fragment specific for the protein and measuring the amount of antibody-bound protein.
- Antibodies can be labeled by radioactive, fluorescent or other detectable reagents to facilitate detection. Methods of detection include, without limitation, enzyme-linked immunosorbent assay (ELISA) and immunoblot techniques.
- ELISA enzyme-linked immunosorbent assay
- the genes that are differentially expressed are either up regulated or down regulated in patients with carcinoma of a particular origin relative to those with carcinomas from different origins. Up regulation and down regulation are relative terms meaning that a detectable difference (beyond the contribution of noise in the system used to measure it) is found in the amount of expression of the genes relative to some baseline. In this case, the baseline is determined based on the algorithm. The genes of interest in the diseased cells are then either up regulated or down regulated relative to the baseline level using the same measurement method.
- Diseased in this context, refers to an alteration of the state of a body that interrupts or disturbs, or has the potential to disturb, proper performance of bodily functions as occurs with the uncontrolled proliferation of cells.
- someone is diagnosed with a disease when some aspect of that person's genotype or phenotype is consistent with the presence of the disease.
- the act of conducting a diagnosis or prognosis may include the determination of disease/status issues such as determining the likelihood of relapse, type of therapy and therapy monitoring.
- therapy monitoring clinical judgments are made regarding the effect of a given course of therapy by comparing the expression of genes over time to determine whether the gene expression profiles have changed or are changing to patterns more consistent with normal tissue.
- Genes can be grouped so that information obtained about the set of genes in the group provides a sound basis for making a clinically relevant judgment such as a diagnosis, prognosis, or treatment choice. These sets of genes make up the portfolios of the invention. As with most diagnostic Markers, it is often desirable to use the fewest number of Markers sufficient to make a correct medical judgment. This prevents a delay in treatment pending further analysis as well unproductive use of time and resources.
- One method of establishing gene expression portfolios is through the use of optimization algorithms such as the mean variance algorithm widely used in establishing stock portfolios. This method is described in detail in 20030194734. Essentially, the method calls for the establishment of a set of inputs (stocks in financial applications, expression as measured by intensity here) that will optimize the return (e.g., signal that is generated) one receives for using it while minimizing the variability of the return. Many commercial software programs are available to conduct such operations. "Wagner Associates Mean- Variance Optimization Application,” referred to as “Wagner Software” throughout this specification, is preferred. This software uses functions from the “Wagner Associates Mean- Variance Optimization Library" to determine an efficient frontier and optimal portfolios in the Markowitz sense is preferred. Markowitz (1952). Use of this type of software requires that microarray data be transformed so that it can be treated as an input in the way stock return and risk measurements are used when the software is used for its intended financial analysis purposes.
- the process of selecting a portfolio can also include the application of heuristic rules.
- such rules are formulated based on biology and an understanding of the technology used to produce clinical results. More preferably, they are applied to output from the optimization method.
- the mean variance method of portfolio selection can be applied to microarray data for a number of genes differentially expressed in subjects with cancer. Output from the method would be an optimized set of genes that could include some genes that are expressed in peripheral blood as well as in diseased tissue. If samples used in the testing method are obtained from peripheral blood and certain genes differentially expressed in instances of cancer could also be differentially expressed in peripheral blood, then a heuristic rule can be applied in which a portfolio is selected from the efficient frontier excluding those that are differentially expressed in peripheral blood.
- the rule can be applied prior to the formation of the efficient frontier by, for example, applying the rule during data pre-selection.
- heuristic rules can be applied that are not necessarily related to the biology in question. For example, one can apply a rule that only a prescribed percentage of the portfolio can be represented by a particular gene or group of genes.
- Commercially available software such as the Wagner Software readily accommodates these types of heuristics. This can be useful, for example, when factors other than accuracy and precision (e.g., anticipated licensing fees) have an impact on the desirability of including one or more genes.
- the gene expression profiles of this invention can also be used in conjunction with other non-genetic diagnostic methods useful in cancer diagnosis, prognosis, or treatment monitoring.
- other non-genetic diagnostic methods useful in cancer diagnosis, prognosis, or treatment monitoring.
- a range of such Markers exists including such analytes as CA 27.29.
- blood is periodically taken from a treated patient and then subjected to an enzyme immunoassay for one of the serum Markers described above. When the concentration of the Marker suggests the return of tumors or failure of therapy, a sample source amenable to gene expression analysis is taken.
- FNA fine needle aspirate
- the present invention provides a method for analyzing a biological specimen for the presence of cells specific for an indication by: a) enriching cells from the specimen; b) isolating nucleic acid and/or protein from the cells; and c) analyzing the nucleic acid and/or protein to determine the presence, expression level or status of a Biomarker specific for the indication.
- the biological specimen can be any known in the art including, without limitation, urine, blood, serum, plasma, lymph, sputum, semen, saliva, tears, pleural fluid, pulmonary fluid, bronchial lavage, synovial fluid, peritoneal fluid, ascites, amniotic fluid, bone marrow, bone marrow aspirate, cerebrospinal fluid, tissue lysate or homogenate or a cell pellet. See, e.g. 20030219842.
- the indication can include any known in the art including, without limitation, cancer, risk assessment of inherited genetic pre-disposition, identification of tissue of origin of a cancer cell such as a CTC 60/887,625, identifying mutations in hereditary diseases, disease status (staging), prognosis, diagnosis, monitoring, response to treatment, choice of treatment (pharmacologic), infection (viral, bacterial, mycoplasmal, fungal), chemosensitivity 7112415, drug sensitivity, metastatic potential or identifying mutations in hereditary diseases.
- cancer risk assessment of inherited genetic pre-disposition
- identification of tissue of origin of a cancer cell such as a CTC 60/887,625, identifying mutations in hereditary diseases, disease status (staging), prognosis, diagnosis, monitoring, response to treatment, choice of treatment (pharmacologic), infection (viral, bacterial, mycoplasmal, fungal), chemosensitivity 7112415, drug sensitivity, metastatic potential or identifying mutations in hereditary diseases.
- Cells enrichment can be by any method known in the art including, without limitation, by antibody / magnetic separation, (Immunicon, Miltenyi, Dynal) 6602422, 5200048, fluorescence activated cell sorting, (FACs) 7018804, filtration or manually.
- the manual enrichment can be for instance by prostate massage. Goessl et al. (2001) Urol 58:335-338.
- the nucleic acid can be any known in the art including, without limitation, is nuclear, mitochondrial (homeoplasmy, heteroplasmy), viral, bacterial, fungal or mycoplasmal.
- DNA analysis can be any known in the art including, without limitation, methylation - de-methylation, karyotyping, ploidy (aneuploidy, polyploidy), DNA integrity (assessed through gels or spectrophotometry), translocations, mutations, gene fusions, activation - de-activation, single nucleotide polymorphisms (SNPs), copy number or whole genome amplification to detect genetic makeup.
- RNA analysis includes any known in the art including, without limitation, q- RT-PCR, miRNA or post-transcription modifications.
- Protein analysis includes any known in the art including, without limitation, antibody detection, post-translation modifications or turnover.
- the proteins can be cell surface markers, preferably epithelial, endothelial, viral or cell type. The Biomarker can be related to viral / bacterial infection, insult or antigen expression.
- the claimed invention can be used for instance to determine metastatic potential of a cell from a biological specimen by isolating nucleic acid and/or protein from the cells; and analyzing the nucleic acid and/or protein to determine the presence, expression level or status of a Biomarker specific for metastatic potential.
- the cells of the claimed invention can be used for instance to identify mutations in hereditary diseases cell from a biological specimen by isolating nucleic acid and/or protein from the cells; and analyzing the nucleic acid and/or protein to determine the presence, expression level or status of a Biomarker specific for specific for a hereditary disease.
- the cells of the claimed invention can be used for instance to obtain and preserve cellular material and constituent parts thereof such as nucleic acid and/or protein.
- the constituent parts can be used for instance to make tumor cell vaccines or in immune cell therapy. 20060093612, 20050249711.
- Kits made according to the invention include formatted assays for determining the gene expression profiles. These can include all or some of the materials needed to conduct the assays such as reagents and instructions and a medium through which Biomarkers are assayed.
- Articles of this invention include representations of the gene expression profiles useful for treating, diagnosing, prognosticating, and otherwise assessing diseases. These profile representations are reduced to a medium that can be automatically read by a machine such as computer readable media (magnetic, optical, and the like).
- the articles can also include instructions for assessing the gene expression profiles in such media.
- the articles may comprise a CD ROM having computer instructions for comparing gene expression profiles of the portfolios of genes described above.
- the articles may also have gene expression profiles digitally recorded therein so that they may be compared with gene expression data from patient samples. Alternatively, the profiles can be recorded in different representational format. A graphical recordation is one such format. Clustering algorithms such as those incorporated in "DISCOVERY” and "INFER” software from Partek, Inc. mentioned above can best assist in the visualization of such data.
- articles of manufacture are media or formatted assays used to reveal gene expression profiles. These can comprise, for example, microarrays in which sequence complements or probes are affixed to a matrix to which the sequences indicative of the genes of interest combine creating a readable determinant of their presence.
- articles according to the invention can be fashioned into reagent kits for conducting hybridization, amplification, and signal generation indicative of the level of expression of the genes of interest for detecting cancer.
- the present invention defines specific marker portfolios that have been characterized to detect a single circulating breast tumor cell in a background of peripheral blood.
- the molecular characterization multiplex assay portfolio has been optimized for use as a QRT-PCR multiplex assay where the molecular characterization multiplex contains 2 tissue of origin markers, 1 epithelial marker and a housekeeping marker. QRT-PCR will be carried out on the Smartcycler II for the molecular characterization multiplex assay.
- the molecular characterization singlex assay portfolio has been optimized for use as a QRT-PCR assay where each marker is run in a single reaction that utilizes 3 cancer status markers, 1 epithelial marker and a housekeeping marker.
- the molecular characterization singlex assay will be run on the Applied Biosystems (ABI) 7900HT and will use a 384 well plate as it platform.
- the molecular characterization multiplex assay and singlex assay portfolios accurately detect a single circulating epithelial cell enabling the clinician to predict recurrence.
- the molecular characterization multiplex assay utilizes Thermus thermophilus (TTH) DNA polymerase due to its ability to carry out both reverse transcriptase and polymerase chain reaction in a single reaction.
- TTH Thermus thermophilus
- the molecular characterization singlex assay utilizes the Applied Biosystems One-Step Master Mix which is a two enzyme reaction incorporating MMLV for reverse transcription and Taq polymerase for PCR. Assay designs are specific to RNA by the incorporation of an exon-intron junction so that genomic DNA is not efficiently amplified and detected.
- the present invention demonstrates the method to capture the CTCs and culture them in vitro. The experiment and the results are described below. There are several novel aspects of this invention.
- the invention is the first demonstration of the combination of multiplex qRTPCR assays and the CellSearch technology for enrichment of circulating epithelial cells. We provide detailed description on novel methods developed to isolate the RNA after enrichment and use of the RNA in a qRTPCR assay.
- the invention can be used as a surrogate for the cells themselves.
- a final key aspect of the invention is that, by using a quantitative multiplex assay, one may be able to generate an algorithm based on two or more genes to generate prognostic information on patients from whom one has isolated circulating tumor cells. Importantly, the molecular information may provide additional or even new prognostic information when combined with the enumeration of circulating epithelial cells.
- the Molecular characterization singlex assay is based on Quantitative Reverse Transcriptase Polymerase Chain Reaction (QRT-PCR) where each marker is run in an individual reaction.
- QRT-PCR Quantitative Reverse Transcriptase Polymerase Chain Reaction
- the present invention describes the use of 3 tissue of origin markers, 1 epithelial marker for confirmation that circulating tumor cells are present from breast cancer and a control marker for verification of sample quality.
- Specific primer/probe combinations for each marker are designed to result in high specificity and sensitivity analysis for predicting recurrence in breast cancer patients.
- These primer/probe combinations for specific markers are optimized for the Applied Biosystems (ABI) 7900HT platform to detect a single circulating breast tumor cell in a background of peripheral blood. Results from this assay show that it could be used in parallel with the CellSearchTM CTC Kit enumeration kit and thus is beneficial to both the clinician and patient for predicting recurrence.
- the Molecular characterization breast multiplex assay is also based on QRT-PCR, however in contrast to the singlex assay presented above, patient sample is analyzed in a single reaction with 3 diagnostic markers enabling a higher percentage of detection.
- the present invention describes the use of 2 tissue of origin markers, 1 epithelial marker for confirmation that circulating tumor cells are present from breast cancer and a control marker for verification of sample quality.
- Specific primer/probe combinations for each marker are designed to result in high sensitivity while very specific in a background of peripheral blood leukocytes PBLs. Feasibility of these applications are demonstrated by the ability of this assay to detect ⁇ 5 SKBR3 cells spiked into 7.5ml of peripheral blood.
- the molecular characterization assay is based on qRTPCR for the characterization of circulating prostate cells.
- a very sensitive multiplex assay incorporates 1 epithelial marker (CKl 9), one prostate tissue of origin marker (PSA, also known as kallikrein 3), and one control gene (PBGD). This assay can also be used for the highly sensitive detection of prostate cells.
- CKl 9 1 epithelial marker
- PSA prostate tissue of origin marker
- PBGD control gene
- the present invention provides a method to culture CTCs from blood.
- the process involves use of CellSearchTM technology and its associated CellTracks® AutoPrep system and CellSearchTM Profile Kit. These propagated cells could be used in pharmacogenomic studies and also to extract the nucleic acids in sufficient quantities for use in molecular profiling studies. Finally, this assay could also be used as a confirmatory tool in combination with the enumeration results of CTCs.
- the present invention provides a method to detect methylation markers in DNA from ⁇ 5 cell equivalents (3 cells in this study) following the sodium bisulfite conversion.
- the process involves a pre-amplification of target region followed by a multiplex QMSP.
- the invention is the first demonstration of the combination of multiplex QMSP (involving nested PCR) assays and its extension to the CellSearchTM technology that enriches the circulating tumor cells (CTCs).
- CTCs circulating tumor cells
- QMSP assay may provide useful information on several molecular markers thus making it more sensitive when combined with CellSearchTM technology.
- multiplex QMSP assay may be able to provide a new prognostic method for multiple tumor cell detection, for example, prostate and breast cancers.
- this assay could also be used as a confirmatory tool in combination with the enumeration result of CTCs.
- the present invention defines Methylation specific marker portfolios that have been characterized to detect ⁇ 20 ⁇ g of DNA after Sodium Bisulfite Conversion, equivalent to 3 circulating tumor cell, in a background of peripheral blood Leukocyte (PBL), equivalent to 10,000 to 100,000 PBL.
- PBL peripheral blood Leukocyte
- the molecular characterization multiplex contains 1 DNA Methylation Specific marker and a housekeeping marker (additional 2 of DNA Methylation Specific markers will be added soon).
- Genomic DNA will be subjected to sodium bisulfite conversion and purification using ZymoResearch Kit.
- a pre-amplification of target regions using nested primer sets (outer primers) will be carried out on a thermocycler.
- a fluorescent signal will be generated by using inner primers with a Scorpion probe design on Cepheid's Smartcycler® or equivalent platform. Table I. PCR Primer se uences
- the first PCR (pre-amplification) reaction reagent formulations and cycling conditions as follows: Table II. Reagents for pre-amplification PCR
- CpGenome Universal methylated DNA CpG M
- PC Prostate Adenocarcinoma DNA
- PN Prostate Normal DNA
- QMSP reactions were carried out after sodium bisulfite conversion. The following examples are meant to illustrate but not limit the invention.
- the assays from the molecular characterization singlex assay portfolio include a junction- specific PCR probe that eliminates amplification of genomic DNA.
- the primer and dual-labeled hydrolysis probe sequences tested for this sample are shown below:
- RNA was serially diluted to represent 1-400 cell equivalents (CE). The serially diiuted RNA was then spiked into a background leukocyte total RNA equivalent to 50,000CE. Quantitative Real-Time PCR was applied and results of optimal assays supporting this invention are shown below.
- Example #1 Samples were prepared and transcripts amplified in the same manor as described in Example #1. Results of these alternative assays supporting this invention are shown below. When compared to the performance of markers in Example #1 the following results demonstrate assays that have inferior performance mostly contributed to lack of marker specificity and/or sensitivity and poor primer or probe design.
- the molecular characterization assay will combine the cell capture portion of CellSearch technology with a molecular detection assay.
- the sensitivity of the CellSearch assay may be improved by utilizing a molecular detection technology capable of detecting marker expression in both intact cells and cell fragments typically not called positive by the CellSearch assay. Isolation of RNA using immunomagnetically enriched SKBR3 and MCF7 cells spiked into healthy donor blood drawn into EDTA anticoagulant blood tubes was carried out as shown below.
- the assays from the RPA multiplex assay portfolio include a junction-specific PCR probe that eliminates amplification of genomic DNA.
- the primer and dual-labeled hydrolysis probe sequences tested for this sample are shown below:
- RNA was serially diluted to represent 1-125 cell equivalents (CE). The serially diluted RNA was then spiked into a background leukocyte total RNA equivalent to 50,000CE. Quantitative Real-Time PCR was applied and results supporting this invention are shown below.
- Molecular characterization Multiplex assay will combine the cell capture portion of CellSearch technology with a molecular detection assay.
- the sensitivity of the CellSearch assay may be improved by utilizing a molecular detection technology capable of detecting marker expression in both intact cells and cell fragments typically not called positive by the CellSearch assay.
- Isolation of RNA using immunomagnetically enriched SKBR3 cells transcribing only CKl 9 spiked into healthy donor blood drawn into EDTA anticoagulant blood tubes was carried out as shown below, hi contrast to the molecular characterization Singlex assay where a patient sample has to be divided between all reactions, the molecular characterization Multiplex assay offers increased sensitivity by enabling the user to analyze the molecular profile of an entire sample in a single reaction.
- RNA stability of intracellular RNA was evaluated through QRT-PCR using the molecular characterization Multiplex assay over a 48 -hour time course.
- 200 SKBR3 cells were spiked into multiple tubes of 7.5 ml of healthy donor blood.
- samples were processed using the cell capture portion of CellSearch technology and the CellSearch Profile Kit. After RNA isolation samples were analyzed and results are shown in the table below and Figure 1.
- the present invention provide methods, apparatus and kits for sample processing of circulating tumor cells (CTC) within peripheral blood and assessing their gene expression profiles while providing support for the Cell search platform for disease recurrence testing. Examples show the ability to detect a single circulating tumor cells in a background of peripheral blood using a novel multiplex assay that offers increased advantages over traditional singlex RT- PCR assays.
- CTC circulating tumor cells
- Prostate RNA was spiked into RNA from leukocytes and tested in a multiplex assay on the Cepheid Smartcycler II. Representative data is shown below and in Figure 2. Average Ct value prostate RNA (pg) PBGD w/PBL KLK3 w/PBL CK19 w/PBL
- RT-PCR detection is generally inconsistent because the concentration of extracted RNA from circulating tumor cells is often very low.
- Two-round QRT-PCR using nested primers enhances both the specificity and sensitivity of the assay specifically those working with low or poor quality target or rare messages. This method incorporates two pairs of primers that are used to amplify first a larger template nucleic acid
- Nested multiplex amplification reaction was carried out on the Smartcycler II using the following cycling conditions and reagent formulations as follows: As described above, serially diluted SKB R3 RNA spiked into a background of leukocyte total RNA was used in the following example. Reagents FC X1 (25ul)
- tubes are spun and a three micro liter aliquot is drawn from the first tube and expelled into a second tube containing the following primers, probes and reagents.
- Quantitative Real-Time PCR was applied using the following parameters and results supporting this invention are shown below.
- Breast RPA nested QRT-PCR multiplex assay will be used in conjunction with the CellSearch enrichment to improve molecular detection technology capable of detecting marker expression in both intact cells and cell fragments typically not called positive by the CellSearch CTC assay. Isolation of RNA using immunomagnetically enriched SKBR3 cells spiked into healthy donor blood drawn into EDTA anticoagulant blood tubes was carried out as shown below. In contrast to the one round RPA QRT-PCR assay where sensitivity and specificity are low, the two round breast RPA nested QRT-PCR offers increased sensitivity and specificity by enabling the user to have near single copy sensitivity.
- Nested multiplex amplification reaction was carried out on the Smartcycler II using the following cycling conditions and reagent formulations as follows: As described above, serially diluted LNCAP RNA spiked into a background of leukocyte total RNA was used in the following example. Reagents X1 (25ul)
- tubes are spun and a three micro liter aliquot is drawn from the first tube and expelled into a second tube containing the following primers, probes and reagents.
- Quantitative Real-Time PCR was applied using the following parameters and results supporting this invention are shown below.
- Prostate MCA nested QRT-PCR multiplex assay will be used in conjunction with the CellSearch enrichment to improve molecular detection technology capable of detecting marker expression in both intact cells and cell fragments typically not called positive by the CellSearch CTC assay.
- Isolation of RNA using immunomagnetically enriched LNCAP cells spiked into healthy donor blood drawn into EDTA anticoagulant blood tubes was carried out as shown below.
- the two round prostate MCA nested QRT-PCR offers increased sensitivity and specificity by enabling the user to have near single copy sensitivity.
- SKRB3 cells were spiked at 1000 cells into 7.5 mL of donor blood (purple top Vacutainer® with EDTA as preservative) as shown in Table I. Table I. Spiking of SKBR3 cell lines into donor blood
- the CTCs were captured by EpCAM conjugated immunomagnetic beads using CellSearchTM Profile Kit and CellTracks® AutoPrep system.
- the tubes containing the captured CTCs were removed from the system and placed in Magcellect® magnet, incubated for 10 min. The supernatant was removed with the tube still in Magcellect®.
- the pellet was suspended in 200 ⁇ L of phosphate buffered saline (PBS).
- PBS phosphate buffered saline
- the cell suspension was plated into a 48-well plate containing 1.0 mL per well of complete Eagle's Minimal Essential Medium with 10% fetal bovine serum (FBS).
- the cells were qualitatively assessed for up to 14 days during the growth and the results of the observation are summarized in Table II.
- RNA samples were washed twice with PBS and lysed directly in the well using RLT buffer (Qiagen). Total RNA from the lysates was isolated by using RNeasy Micro Kit (Qiagen). These RNA samples will be used for further analyses including global gene expression. Results:
- the leukocytes die off within 2 days of culture thus not interfering with the CTC growth
- the CTCs were seen to be dividing although slower than the control parental cells as expected
- the doubling time of growth for the CTCs was about >2x compared to parental cells A difference in growth properties (quality and viability) was observed between the 2 replicates suggesting a possible effect from the donor blood
- Ct values for direct or pre-amplified template DNA are shown in the following table and Figure 4.
- CpG M DNA (equivalent to 7 cells) in a background of 100 ng or 500 ng of PBL (equivalent to 10,000 or 70,000 cells, respectively) was detected using QMSP with or without pre-amplification. Good linear response curves were generated for both pre-amplification and direct amplification reactions.
- ⁇ 20pg ofDNA from prostate adenocarcinoma equivalent to 3 circulating tumor cells, generated a signal specific to methylated GSTPl region and was detected in a background of 70,000 PBL cells.
- no detectable signal from normal prostate (PN) or blood (PBL) DNA was observed suggesting the absence of methylated GSTPl.
- Nested QMSP sensitivity of detection of 1 copy in a background of 2.5xlO 4 copies (20pg of methylated DNA in 500ng of unmethylated DNA) is observed. No significant non-specific products were detected with nested QMSP method and the correct size of final PCR fragments were observed on the gel (data not shown). Further assay optimization experiments are underway to increase the detection sensitivity and to reduce the Ct value for ⁇ 3 cells.
- Prostate tumor cell lines (LnCAP and DU-145) grown in culture were spiked at 30, 100, 300 and 500 cells into 7.5 ml of donor blood followed by capturing CTCs by CellTracksTM AutoPrep system of CellSearchTM platform using Profile Kit. Deoxyribonucleic acid from these cells was isolated using Qiagen microcolumns and subjected to bisulfite conversion reaction. The modified DNA from the last step was used in a 2 round q-MSP reaction using the conditions in Table III (22 cycles) and Table V. The results from the experiments are shown in Tables VIII and DC. Table VIII. Ct values from CTCs (spiked cells, LnCAP)
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